Warning. I came back up to say I've written a novel. Maybe some of my experiences will help. (But at any rate, it felt really good to write about it so don't feel like you have to read it all!)
We've actually had a good experience at two memory care places, one where both of my parents lived in their town, and one where my mom lives near me. However, we were admittedly at the priciest places in town. Both were places that have a big building with residential apartments and assisted living and then a smaller building adjacent with memory care.
At mom's current memory care, and similarly at the other, some of the residents who desire or need socialization and/or more supervision are brought out of their rooms and hang out in the open areas, but most choose to spend quite a bit of time in their rooms if they're not in an activity or at the tv lounge. They used to really encourage my dad to come out and participate, sometimes luring him out with a snack, etc. When they had to quarantine dad due to a covid exposure back in 2020 and mom was still in the other building in assisted living, they hired more people on and he had almost constant supervision to keep him in his room and entertained. (Obviously mom couldn't visit him then - and neither could we.) We moved her into her own room near him in Memory care (they couldn't be together anymore because he'd keep her up all night asking questions) a bit earlier than she needed to ride out the pandemic with him since they were both suffering with the separation (we could only visit them both on our phones through a window) but now he has passed and she is in memory care due to her own need. Can you imagine trying to keep several mobile residents in their own rooms to quarantine when it's illegal to lock them in their rooms and they can't remember that they have to stay there? Normally we would have to pay more care points to get that kind of supervision but didn't under those circumstances. Honestly, those employees deserve the world for all they did!
My mom is still choosing her own entertainment and only really comes out for meals and the activities she likes to participate in. The current place has a calendar full of activities they invite them each to and at this place I can tell what she has participated in on a "Patient portal" - and what she has declined. (nothing like that at the other - it was smaller.) Participation is defined by present during that activity, so if she is listed as declined I know she was probably in her room since she doesn't like to watch tv in the tv lounge or just hang out. My mom likes to go to meals, snacks, exercise class, walking (and rolling) activities (they even take them on a bus to the mall for the am walking before it opens sometimes) and any music groups that come to visit. They offer a lot of games, movies, tv lounge etc. too but she isn't interested. She does go to holiday parties, etc. There are all levels of needs represented so those that are more "present" tend to find each other to sit together at meals etc. We got her a twin sized bed so there is room for a loveseat and side chair facing her dresser with her tv on top to make a little living room. She refers to her room as her apartment and feels very comfortable there. I stop in to visit her 4 or 5 days a week now that she is close, only a few minutes away, and she enjoys watching tv. (she wants to watch CNN all day, ick!)
While there are times of the day they only have "supervision," mom's current place has activity staff 7 days a week. (Their old one only had it five and she used to be a lot more agitated on weekends, calling me more, complaining of boredom, etc.) Now she seems quite content. I definitely see more constant care than in assisted, where they were expected to be able to call/ask for help as needed. However, it's not constant supervision. They have fall cameras in the rooms so they can detect if someone has fallen out of bed or in the bathroom. (They show kind of dark shapes for privacy reasons.) There are a few stroke victims etc. that have good memory but need more supervision that are there. One man in mom's area spends a lot of his time in his wheelchair near where the med aide does a lot of his/her work so he can socialize as people come and go. Most of the employees stop to talk and so do most of us that visit regularly since we know he needs/wants to socialize on a slightly higher level.
Even though it is memory care and there are a lot of people who really don't have much memory function hanging out in the periphery, I think it is much more interactive than when I've visited friends and family in nursing homes. It's all about activities and working on ADLs rather than medical stuff. There is definitely more interaction with staff than in assisted living, and it is focused differently. There have been times (after dad's death at the old place, after a fall at the new) where she's been put "on watch" and gets more frequent checks. She's always talking about how clean they keep the rooms because they come in to "empty her garbage cans,"etc. all the time. She totally doesn't clue into that and doesn't feel like she's being medically observed at all. They probably knock and enter her room well over a dozen times a day for meal time reminders, 4 med runs, snacks, activity invitations and the "checking of the garbage cans." She doesn't have any care points for bathing/toileting and she does not require nighttime checks unless they see something on the fall camera, or see her up moving around so I can't say how often they might check as a norm. (Her new place has fall cameras ,their old place had dutch doors so they could swing open the top and look in or keep them open depending on need.)
I'm not sure what it will start to look like as she approaches hospice. Dad did require an increase in care points when he became a two person assist and required care points for bathing, etc. However Dad's time where he was bedridden was very short (only a few days) so we all traveled there and took turns so he had lots of supervision and he was gone before we had to set anything up. If he was awake and not being supervised, we had the staff keep playing "Lawrence Welk" episodes from
youtube on his smart tv and he would hum along. Even while still in the midst of covid restrictions, we were allowed to be there at all hours once he was at end of life status.
I would find out how many checks they do, if you can increase care points and get more checks, how often hospice and home health come and how that coordinates. Find out what hospice requires in terms of supervision and how the facility will handle it once the night nurse leaves. Then figure out if there are gaps you or family/friends can fill and work from there. I'm hoping my mom can stay in memory care and not have to go full nursing and that worked for dad. We have found staffing to be a real challenge and have felt both places (in two different states) were short staffed at times through the last couple of years, but that seems to be evening out.
I'm wishing you the best as you go through this challenging time!
) and the whole atmosphere was very stressful. The facility was very clean and the physical care, nutrition and hygiene needs were adequately satisfied. There was a roster of exercise and activities but honestly, hardly any of the residents were capable of participating.
